Healthcare Provider Details

I. General information

NPI: 1407358187
Provider Name (Legal Business Name): SANTEE CHIROPRACTIC CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 BASS DR
SANTEE SC
29142-8797
US

IV. Provider business mailing address

627 BASS DR
SANTEE SC
29142-8797
US

V. Phone/Fax

Practice location:
  • Phone: 803-813-4357
  • Fax: 803-813-5205
Mailing address:
  • Phone: 803-813-4357
  • Fax: 803-813-5205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2326
License Number StateSC

VIII. Authorized Official

Name: DR. PATRICK W LEONARD
Title or Position: DR./OWNER
Credential: DC
Phone: 803-813-4357